The primary goal of this project is to demonstrate that high-speed computers and networks can dramatically improve the provision of dermatologic care by making routine dermatologic diagnosis ("teledermatology") practical within the next three years. The project consists of mutually supporting basic and applied research programs which will be conducted simultaneously over a three year period. The basic research program involves the specification and design of an economical and useful teledermatology system. Factors to be studied include spatial and color resolution requirements, image compression schemes, equipment needed to produce acceptable results over side-area networks, and protocols for skin image transmission and storage. The applied research program will study the use of teledermatology as a means of improving the ability of primary care physicians to recognize and treat skin cancers and other skin conditions of clinical importance. ROC analysis and general knowledge testing will be used to determine the dermatology knowledge base of primary care physicians in rural areas. The contractor will then devise and install a basic teleldermatology imaging and transmission system in at least 3 primary care clinics in rural Oregon which collectively serve over a dozen primary care physicians. Dermatologists in Portland will provide teledermatology consultation services to these primary care physicians for a period of three years, while data on use patterns, information flow, and the system's effect on treatment plans is collected by the investigators. The level of dermatology knowledge of the primary care providers will then be retested at intervals.